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Supply low... what else can I do? I feel like a failure

Hi ladies. I've posted on here several times about various issues. I'm at a loss and I don't know what to do. My son will be one month old tomorrow and we are still having breastfeeding problems. I will start by saying that I have worked with the lactation consultants in my area already (as I know this will be a suggestion).
Just a bit of background. I was exclusively breastfeeding until 2 1/2 weeks. My son wasn't gaining his weight back and was always seeming hungry. I was nursing every 1 1/2 - 2 hours around the clock. In addition, in order to get up my supply up I was pumping after every feeding and then giving him what was left (which was not very much!) I started on herbs (fenugreek), drank plenty of water, etc. He was still starving. We supplemented (per our pediatrician suggestion due to not gaining weight) with formula. Whenever I supplemented, I made sure to pump (even at 3:00 in the morning!)
Well, I just can't make enough milk!! When I pump I barely get 1-2 ounces the most! (I know that pumping isn't a good indication of what the baby gets!) However, when we weigh him before and after, I see that he isn't getting more than 1-2 ounces. After about 5-10 minutes of vigorous sucking, he pulls off and gets annoyed b/c it's dry.
What else can I do to build supply?? I'm at a loss. I want to get back to exclusively breastfeeding, but it doesn't seem possible.
I feel like such a failure. I'm fit, eat really healthy, and am in perfect health. Why is this happening? Also, who do I talk to about this? Do I talk to my pediatrician or my midwife?

Re: Supply low... what else can I do? I feel like a failure

I think I'd try talking to my midwife first. I could be wrong, but I think she'd be more likely to have information about breastfeeding as far as supply issues than the pediatrician would. It sounds like you're doing everything you can think of--this is just a question based on my experience when I was pumping--do you think your stress level about it could be impeding you? It got to the point where I was so stressed about not being able to pump anything that I really think that made it even less likely that I could let down. One thing that seemed to help was soaking in a hot bath and making sure my breasts were in the water too; I don't know if it was the warm water or the relaxing effect of the bath (or a combination), but that usually helped. I hope it gets easier--I know it's frustrating. Good for you for hanging in there!

Re: Supply low... what else can I do? I feel like a failure

It's nice to see you back here. I've been wondering how you were doing, and I'm really sorry to hear that breastfeeding still isn't going as smoothly as one would hope.

I second the advice to call your midwife first. Pediatricians can be pretty clueless about breastfeeding! Some physical issues that can cause low supply include polycystic ovarian syndrome (PCOS), and as others have mentioned, thyroid problems (very common in postpartum women) and fragments of retained placenta. You may also want to discuss the prescription drugs Reglan (available in the US) and Domperidone (available in the EU and Canada) with your midwife. Both are anti-reflux drugs that can increase prolactin levels and milk supply. Both have side-effects. Reglan in particular is associated with an increased risk for depression, so discussing any family or personal history of that condition with your midwife is a must. (FWIW, I took Reglan, and had no side-effects despite a family history of depression.)

I can't recall what kind of pump you are using- is it a hospital-grade pump or something else? If you haven't got a hospital-grade pump, I'd really advise getting one, as they do give much better results.

You mention that you're pumping every time you supplement. How often does this translate to? When I had supply issues, I pumped both sides for 15-20 minutes every 2 hours during the day and every 3 at night, and I saw good results in a hurry.

You might want to try supplementing your baby at the breast using a supplemental nursing system (SNS). That way your baby will learn that all his meals come at the breast, and he will stimulate your supply even as he feeds from the SNS.

I think you are doing a terrific job- your baby is getting breastmilk, and a lot of it, even if it isn't making up the totality of his diet. You should not feel like a failure- you haven't given up and you're doing the hardest job in the world!!!

Re: Supply low... what else can I do? I feel like a failure

Assuming that there's not a physical reason that you jave a low supply (like a placenta remnant), it sounds like you're already doing a lot to increase your supply. My situation was a lot like yours - vigorous nursing, good latch, but slow weight gain and a baby that cried after each nursing session in the evening. Many will question whether you truly have a low milk supply, but it does happen. If you have worked with your LC and this is a legitimate concern, then there are a couple other things you can consider to help build supply.

You might talk to your LC about using Reglan or domperidone. Reglan has some side effects that can be difficult fo rnew moms, specifically depression. This is of special concern for anyone who is already prone to depression. Domperidone is recommended by the pediatrics association to help moms increase milk suppy, but it is not approved by the FDA for this use and can be difficult to get a prescription for from your healthcare provider. It is, however, available for purchase from New Zealand by Internet.

Domperidone was suggested by my LC but my husband was uncomfortable with the idea. So, I did two rounds of Reglan and pumped every three hours for 20 minutes to build my supply using a rented hospital grade pump. I quickly went from less than two ounces per session to five or six. I now have 32+ ounces per day - more than enough for my LO and some each day for the freezer.

However, a big caution here - if you want your baby to go back to the breast once you get your supply built, please check out the link provided in the pp about the SNS. My baby was quick to figure out that the bottle was faster, more consistent flow, and overall easier and eventually refused to nurse at all. At that point, I was stuck pumping and bottle feeding to get breastmilk to my LO. I really wish I had used the SNS right out of the hospital for the jaundice and low supply supplementing I had to do.

Be kind to yourself. You are doing such a good job and are obviously trying so hard to give your LO the best nutritional and emotional start in life. It's hard, but part of the low supply battle is learning to accept that you're doing all that you can do at the moment and being OK with that. Providing some of your LO's needs with bf and supplementing with formula is not a failure! It's a success each time you breastfeed or provide EBM.

Keep us posted on how things are going and what your midwife / LC have to say.